AI Article Synopsis
- The study focused on identifying factors linked to periprosthetic fractures in patients with cemented polished tapered stems, specifically Vancouver B and C types.
- Retrospective analysis of 181 fractures showed that 88% were Vancouver B, with notable differences in mortality rates between fracture types, especially at 90 days and 1 year post-fracture.
- Multivariate analysis indicated that female sex was the only independent risk factor for Vancouver C fractures, which were characterized by traits typical of fragility fractures, unlike the more common Vancouver B-type.
Article Abstract
Introduction: The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C.
Methods: A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39-103; mean BMI 27.1, 17-39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures.
Results: 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2-26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R=0.354, p = 0.005).
Conclusion: Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522678 | PMC |
| http://dx.doi.org/10.1007/s00402-021-04113-6 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The Risk of Postoperative Periprosthetic Femoral Fracture After Total Hip Arthroplasty Depends More on Stem Design Than Cement Use: An Analysis of National Health Data from England.
J Bone Joint Surg Am
January 2025
Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, West Yorkshire, England.
Background: In this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).
Methods: In this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems.
Complications following reverse total shoulder arthroplasty for proximal humeral fractures: a systematic review.
JSES Rev Rep Tech
February 2025
UC Davis Department of Orthopaedic Surgery, Oregon Shoulder Institute, Medford, OR, USA.
Background: Reverse total shoulder arthroplasty (rTSA) is an increasingly common procedure for proximal humerus fractures (PHFs), but postoperative complications have not been well characterized. The purpose of this systematic review is to assess complications and revision rates following rTSA in the management of PHFs as documented in current literature.
Methods: A systematic review was performed on primary rTSA for PHFs.
Improved primary stability and load transfer of a customized osseointegrated transfemoral prosthesis compared to a commercial one.
J Orthop Surg Res
January 2025
Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Background: Transfemoral osseointegrated prostheses, like other uncemented prostheses experience the risk of aseptic loosening and post-operative periprosthetic fractures, with an incidence between 3% and 30%. To date, however, osseointegrated off-the-shelf prostheses are manufactured in a limited number of sizes, and some patients do not meet the strict eligibility criteria of commercial devices. A customized osseointegrated stem was developed and a pre-clinical in vitro investigation of the stem was performed, to evaluate its biomechanical performance.
View Article and Find Full Text PDFFetal radiation during acetabular and pelvic ring fixation: Which injury patterns dictate dangerous levels of fluoroscopic cumulative dose.
J Clin Orthop Trauma
March 2025
Department of Orthopaedic Surgery, Mercy St. Vincent Medical Center, 2213 Cherry St., Toledo, OH, 43608, USA.
Background: Gravid females with pelvic fractures are rarely encountered by the orthopaedic trauma surgeon. The initial injury can be detrimental to the pregnant patient, but an unnecessary "second hit" from surgery could also contribute to the outcome of the fetus. Understanding the surgical risks for this unique patient population requires knowledge about the negative effects of anesthesia, surgical exposures, and radiation.
View Article and Find Full Text PDFBackground: There has been an increase in both primary anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) over the last decade, with rates peaking for patients aged 75 years and older. Despite aTSA being the mainstay of treatment for patients with glenohumeral arthritis in the absence of rotator cuff insufficiency, there has been an upward trend of rTSA utilization in the elderly due to concerns about rotator cuff integrity, regardless of deformity. The purpose of this study is to evaluate outcomes including pain, function, range of motion, satisfaction, and complications in patients 80 years or older following primary anatomic and reverse total shoulder arthroplasty for osteoarthritis without full thickness rotator cuff tears.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!